Eye disease treatment fuels funding dispute

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A cheaper drug shouldn't be an option for treating age-related macular degeneration, a leading cause of blindness in seniors, a Canadian lobby group says.

The Canadian Council of the Blind said provincial governments should be funding the approved drug for AMD, Lucentis, not the less expensive treatment that was originally developed to fight colorectal cancer, called Avastin.

Age-related macular degeneration occurs when abnormal blood vessel growth damages the part of the retina responsible for central vision. Avastin (bevacizumab) and Lucentis (ranibizumab) are both injected through the white part of the eye to target a protein that spurs blood vessel growth. The treatment slows the deterioration of a person's eyesight.

An injection of Lucentis costs almost $2,000 compared with a few hundred dollars for Avastin. (CBC)

Since 2008, about 120 Canadians have had serious eye inflammation after receiving injections of Avastin, said Dr. Alan Berger, ophthalmologist in chief at St. Michael's Hospital in Toronto.

Problems can arise because vials of Avastin are sold in larger doses to treat cancer intravenously. For eye injections, the vials are split into smaller doses at a pharmacy, which opens the door to the possibility of contamination.

"If one bottle was contaminated, potentially 20 to 25 people would get those injections," Berger said. "The difference with Lucentis is it is made in individual bottles so from a safety perspective, I would use Lucentis over Avastin certainly for that reason."

Price difference

But the higher price of Lucentis is an issue for some patients and governments. An injection of Lucentis is almost $2,000 compared to a few hundred dollars for Avastin, said Dr. Alan Cruess, chief of ophthalmology and visual sciences at the Capital District Health Authority in Halifax.

Despite the cost, the patient advocacy group said all patients with AMD should get Lucentis.

"If somebody does get an infection or adverse reaction then that is much more costly than the potential $2,000 for one injection," said Louise Gillis, president of the Canadian Council of the Blind.

Complications in U.S.

"Avastin is a very good second alternative and if we didn't have it a lot of people would suffer visually," said Berger. He estimated that if all patients in Ontario had Lucentis covered then costs to the provincial health-care system would at least triple.

Cruess agreed that Avastin is an effective option for those who aren't covered by provincial health plans because of age, for example, or can't afford the hefty co-pay for Lucentis.

Lloyd Mason Sylvis Jr. said his father was a healthy 78-year-old when he went to a veterans' hospital in Nashville, Tenn., for an injection of Avastin into one eye. "He could walk and talk and everything before and now he's permanently blinded and permanently brain damaged."

Investigators in the U.S. believe senior Sylvis was one of about 20 people in that state who received a tainted injection of Avastin. There were 20 similar reports from Florida.

In the U.S., the Department of Veterans Affairs said last week is has stopped using Avastin to treat AMD as it checks reports of increased infection.

A U.S. government-sponsored study released in April concluded that Avastin works just as well as Lucentis for the eye disease, but had more side-effects that required hospitalization.

Although Roche's Genentech sells both drugs, PDL BioPharma Inc. gets royalty payments on Lucentis, and Novartis AG has exclusive rights on it outside the U.S.

Genetech has said that it believes Lucentis is the most appropriate treatment because it was designed and tested with smaller molecules for use in the eye.

In Canada, several provinces are now considering whether to pay for the cheaper drug as well as the approved one.